| NPI | 1730168329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 374457-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 34554) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-05-09 |